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Communique

Weekly Communique # 16

30 July, 2020

Dear colleagues,

On behalf of all members of the Taskforce, we would like to take this opportunity to acknowledge our Victorian colleagues caring for people with COVID-19 during this immensely challenging and anxious time.

Our thoughts are with you as you work to deliver the best possible outcomes for your patients, their families and their loved ones. In doing so, we trust you will also take the best possible care of yourselves and each other.

Sincerely,
Sharon McGowan (Chair, Steering Committee) & Julian Elliott (Executive Director)

 

WEEK IN REVIEW

Vale Dr Harry Nespolon
The Taskforce offers its deepest condolences to the family, friends and colleagues of RACGP President Dr Harry Nespolon, who passed away earlier this week on July 26.

We recognise Dr Nespolon’s extraordinary leadership throughout his career, most recently in helping to shape Australia’s COVID-19 response to enable GPs to deliver high quality care to their patients during the pandemic.

Our sympathies extend to all of those who knew Dr Nespolon well. He will be very sadly missed by many across the country.

Record number of updates
This Taskforce has published a record number of 25 new or updated recommendations this week, as well as updates to all five clinical flowcharts (see below).

A large number of the updates in version 15.0 of the guideline were developed by our Disease Modifying Treatments and Chemoprophylaxis Panel, as well as our special populations panels for Pregnancy and Perinatal Care, Paediatric and Adolescent Care and Palliative and Aged Care.

Major milestones
This week we passed 100,000 website users and 10,000 flowchart views. This represents a remarkable collaborative achievement across member organisations, partners, funders, Taskforce panels, leadership groups and internal teams. We are very grateful to all for their support and tireless contributions each and every week.

 


QUICK STATISTICS

COVID-19 research pipeline

  • 14,326 studies published or registered in Cochrane COVID-19 Study Register, 654 added this week
  • 1,448 randomised controlled trials registered (data from Covid-nma site), 38 added this week
  • 1,789 systematic reviews registered in PROSPERO, 73 added this week
  • 31 randomised controlled trials published (data from Covid-nma site), 1 added this week

 

NEW OR UPDATED RECOMMENDATIONS

Version 15.0

Dexamethasone for adults receiving oxygen
Updated to a strong recommendation fouse of dexamethasone.

Dexamethasone for adults not requiring oxygen
Evidence reviewed with no change to the strength or direction of the recommendation.

Dexamethasone for pregnant or breastfeeding women receiving oxygen
Updated to a strong recommendation for use of dexamethasone.

Dexamethasone for children or adolescents not requiring oxygen
Evidence reviewed with no change to strength or direction of the recommendation.

Hydroxychloroquine 
The evidence base has been updated with no change to the strength or direction of the recommendation. The recommendation has also been updated to reflect that special populations* are now included.

Baloxavir marboxilChloroquineColchicineConvalescent plasmaFavipiravirInterferon β-1aLopinavir/ritonavirRuxolitinib, and Other disease-modifying treatments
The recommendations have been updated to reflect that special populations* are now included. No change to the strength or direction of the recommendation.

Darunavir-cobicistat
New recommendation

For people with COVID-19, do not use darunavir-cobicistat outside of randomised trials with appropriate ethical approval.

Positive end-expiratory pressure
Recommendation reviewed and key information added. No change in strength or direction of the recommendation.

Prone positioning for mechanically ventilated adults
The recommendation has been updated to reflect recommended duration of proning. No change in strength or direction of the recommendation.

Prone positioning for pregnant and postpartum women 
New recommendation

For mechanically ventilated pregnant women with COVID-19 and hypoxaemia despite optimising ventilation, consider prone positioning for more than 12 hours a day.

Recruitment manoeuvres
Recommendation reviewed and key information added. No change in strength or direction of the recommendation.

ECMO for pregnant and postpartum women
New recommendation

Consider referral to an ECMO centre for venovenous ECMO in mechanically ventilated pregnant women with COVID-19 and refractory respiratory failure (despite optimising ventilation, including proning). Delivery of the baby prior to ECMO to enhance maternal resuscitation should be considered on a case-by-case basis.

*Special populations include: pregnant and breastfeeding women, children, older people living with frailty or cognitive impairment and people requiring palliative care.

The Taskforce is continually monitoring research to update recommendations weekly as new evidence accumulates.

 


CLINICAL FLOWCHARTS

Five clinical flowcharts have been developed by the Taskforce to cover:

  • Assessment for suspected COVID-19 UPDATED
  • Management of adults with mild COVID-19 UPDATED
  • Management of adults with moderate to severe COVID-19 UPDATED
  • Management of adults with severe to critical COVID-19 UPDATED
  • Respiratory support for adults with severe to critical COVID-19 UPDATED

Changes to flowcharts this week reflect:

  • New practice point on use of pulse oximeters in adults with mild COVID-19
  • Changes to practice points for management of adults with mild COVID-19
  • Upgraded strength of recommendation for dexamethasone in adults requiring oxygen
  • New recommendation on use of darunavir/cobicistat
  • Added duration of proning for mechanically ventilated patients
  • Amended wording of recommendation on use of ECMO
  • Inclusion of latest guidelines from CDNA (V3.5)

 


 EVIDENCE UNDER REVIEW

We are currently reviewing evidence to develop recommendations and flowcharts to guide practice in areas including:

  • Hydroxychloroquine for post-exposure prophylaxis NEW
  • Immunoglobulin and methylprednisolone NEW
  • Paediatric Multisystem Inflammatory Syndrome (PIMS-TS) NEW
  • Cardiac arrest
  • Convalescent plasma
  • Disease-modifying treatments for pregnant women
  • Disease-modifying treatments for children and adolescents
  • Disease-modifying treatments for people requiring palliative care and frail older people
  • Hydroxychloroquine
  • Non-invasive ventilation
  • Skin to skin contact for parents and newborns

 

HELP US MEASURE OUR IMPACT

We are inviting Australian healthcare practitioners to participate in a brief survey to help us understand how the guidelines and flowcharts developed by the Taskforce are being used, and how we can improve the value of the guidance we develop.

This survey will also be sent to our Taskforce member organisations for their distribution. Participation is voluntary and anonymous.

Please click here to participate and share your thoughts. The survey will be open until 11:59pm, Sunday 16th August.

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